Prolonged school closure may be detrimental not only to education, but also to health:
Across the globe, educational facilities hold a pivotal role in the promotion and maintenance of long-term health, which is complementary to their didactic role. While online schooling partly ensured the continuity of their didactic role, school-based screening and prevention programs were severely disrupted throughout 2020-2021. More time will need to elapse before the consequences of such loss become evident, but a vast heterogeneity of the potential harmful consequences that prolonged school closure and home confinement introduces for the school-aged population and their families, were recognized early in the pandemic by the scientific community operating in the field of developmental paediatrics [56,57] and child psychiatry [58]. Multiple streamlines should be included in such a lifelong investigation of today’s youth, examining changes in the epidemiology of obesity and malnutrition [59], immunization rates, unattended domestic violence and child abuse [60], delays or precocity in cognitive, physical or social growth [57], later diagnoses of developmental conditions, and overall rates of health inequity [61]. However, one year of pandemic has been sufficient for the emergence of one indication of concern: a potentially increased burden of paediatric mental health disorders.
Even on its own, a public health emergency creates multiple stressors for children and adolescents irrespective of their previous mental health status, due to fear of infection, elevated levels of stress and anxiety of caregivers [62,63] and recommended or mandated social isolation [64]. These are further exacerbated with school shutdowns, especially if protracted to an indefinite time, and are supplemented by other stressors, including a disrupted routine, reduced socialization and physical activity, increased screen time and social media consumption, increased boredom, unhealthy or insufficient nutrition, exposure to parental burnout [63], stressors related to school dropout, and others. The cumulative effect of these stressors was partly registered in low-to-high quality studies published early in the pandemic and during lockdowns, consistently finding scores above thresholds for psychological distress, anxiety, depression in substantial a percentage of participants [64-69] and, when comparison was possible, higher than in pre-pandemic cohorts [70]. Adolescents were found to represent a particularly vulnerable cohort [71]. Concomitantly, the clinical frontlines reported both a significant decline in the incidence of admissions for psychiatric emergencies during lockdowns [72-74] and increased suicide ideation and self-harm rates [75]. Such a rise in psychiatric emergencies overall, and specifically in suicide behaviours, is already documented in manifold reports and news article easily found through a Google search: we now await high-quality published studies empirically confirming this alarming trend beyond the grey literature, framing it developmentally as well as clinically. In the difficult trade-off of school closures as pandemic mitigation strategies, policymakers will need a larger body of strong evidences regarding the so-called “hidden epidemic” hitting the younger populations.